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The Fallacy of a Single Diagnosis

Author

Listed:
  • Donald A. Redelmeier

    (Department of Medicine, University of Toronto, Toronto, ON, Canada
    Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
    Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
    Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada)

  • Eldar Shafir

    (Department of Psychology, Princeton University, Princeton, NJ, USA
    Princeton School of Public and International Affairs, Princeton University, Princeton, NJ, USA)

Abstract

Background Diagnostic reasoning requires clinicians to think through complex uncertainties. We tested the possibility of a bias toward an available single diagnosis in uncertain cases. Design We developed 5 different surveys providing a succinct description of a hypothetical individual patient scenaric. Each scenario was formulated in 2 versions randomized to participants, with the versions differing only in whether an alternative diagnosis was present or absent. The 5 scenarios were designed as separate tests of robustness using diverse cases, including a cautious scenario, a risky scenario, a sophisticated scenario, a validation scenario, and a comparative scenario (each survey containing only 1 version of 1 scenario). Participants included community members ( n = 1104) and health care professionals ( n = 200) who judged the chances of COVID infection in an individual patient. Results The first scenario described a cautious patient and found a 47% reduction in the estimated odds of COVID when a flu diagnosis was present compared with absent (odds ratio = 0.53, 95% confidence interval 0.30 to 0.94, P = 0.003). The second scenario described a less cautious patient and found a 70% reduction in the estimated odds of COVID in the presence of a flu diagnosis (odds ratio = 0.30, 95% confidence interval 0.13 to 0.70, P

Suggested Citation

  • Donald A. Redelmeier & Eldar Shafir, 2023. "The Fallacy of a Single Diagnosis," Medical Decision Making, , vol. 43(2), pages 183-190, February.
    • Handle: RePEc:sae:medema:v:43:y:2023:i:2:p:183-190
    DOI: 10.1177/0272989X221121343
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    References listed on IDEAS

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    1. Donald A. Redelmeier & Eldar Shafir & Prince S. Aujla, 2001. "The Beguiling Pursuit of More Information," Medical Decision Making, , vol. 21(5), pages 376-381, October.
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